生活習慣病として認知されるようになって久しい
歯周病ですが、単純な細菌感染症ではなく
背景に生活習慣や遺伝的素因や免疫力も関与している為
短期間の内に治癒し、再発の恐れもない
という理想的な状態に導くことは必ずしも簡単ではありません。
しかし、幸い歯周病分野には多くのエビデンスが
蓄積されていますので、一つずつ自分なりに解釈して
役立てていきたいと思います。
今回は糖尿病と歯周病との関連について
NIDDM、インスリン非依存性のいわゆる
2型糖尿病に罹ると歯周病を発症しやすくなるのか
ピマインディアンを対象に研究した文献です。
720名の2型糖尿病患者と非糖尿病者1553名対象に
喪失歯数とエックス線写真での歯槽骨吸収率を評価項目として
両者の歯周病発症率を比較しています。
The goal of this study was to determine the prevalence and incidence of periodontal disease and its relationship with non-insulin-dependent diabetes mellitus (NIDDM).
Two thousand two hundred seventy-three Pima Indians (949 men, 1324 women) aged greater than or equal to 15 yr from the Gila River Indian Community in Arizona were examined between 1983 and 1989. Periodontal disease was diagnosed by tooth loss and by percentage of interproximal crestal alveolar bone loss ascertained from panoramic radiography. Subjects with little or no evidence of periodontal disease were classified as nondiseased. Thus, the incidence of advanced periodontal disease was determined.
The age- and sex-adjusted prevalence of periodontal disease at first dental examination was 60% in subjects with NIDDM and 36% in those without. Twenty-two new cases developed in a subset of 701 subjects (272 men, 429 women) aged 15-54 yr who initially had little or no evidence of periodontal disease and had at least one additional dental examination. The incidence of periodontal disease in this group was similar in men and women (incidence-rate ratio 1.0, 95% confidence interval [Cl] 0.5-1.9, controlled for age and diabetes). Higher age predicted a greater incidence of periodontal disease (chi 2 = 30.6, df = 3, P less than 0.001, controlled for sex and diabetes). The rate of periodontal disease in subjects with diabetes was 2.6 times (95% Cl 1.0-6.6, controlled for age and sex) that observed in those without. Although periodontal disease was common in nondiabetic Pima Indians, in whom most of the incident cases occurred, diabetes clearly conferred a substantially increased risk. Thus, periodontal disease should be considered a nonspecific complication of NIDDM.
つまり2型糖尿病患者では非糖尿病者の2.6倍の歯周病発症率であり
糖尿病と歯周病は関係があるという結論です。
糖尿病と歯周病に関する文献はたくさん出ていますので
他の 文献も読み進めていこうと思います。
引用文献
Nelson RG1, Shlossman M, Budding LM, Pettitt DJ, Saad MF, Genco RJ, Knowler WC.
Periodontal disease and NIDDM in Pima Indians.
Diabetes Care. 1990 Aug;13(8):836-40.